Primary Care / Family Medicine billing
Specialty
High volume, thin margins, and a lot of small dollars that must all land.
Scope of work
What this service covers
Preventive and problem-oriented visits on the same day
When a wellness visit and a separately identifiable problem visit happen together, the modifier 25 decision, documentation split and payer-specific behaviour decide whether one line, both lines, or neither gets paid.
Annual Wellness Visits and chronic care programmes
AWV frequency rules, initial versus subsequent visit selection, and CCM time-tracking requirements are easy to get wrong at volume — and each error is a small dollar amount repeated hundreds of times.
Eligibility misses at the front desk
Plan changes, coordination of benefits, and same-day add-ons drive avoidable denials. In primary care the visit already happened, so a coverage miss becomes a patient-balance problem rather than a payer problem.
Vaccines and administration codes
Product code, administration code, counting rules, and payer carve-outs to pharmacy benefit all have to line up. Vaccine underpayment is quiet, chronic, and rarely appealed.
Small-balance AR and patient responsibility
High deductible plans push more of every visit onto the patient. A balance below the effort threshold still needs a consistent, respectful follow-up cycle or it silently becomes bad debt.
Timely filing across a mixed payer panel
Different Medicaid plans, commercial payers and Medicare Advantage products all carry different filing windows. High volume makes a missed window expensive before anyone notices.
Interactive model
The shape of primary care revenue
An interactive illustration of the dynamic that defines billing in this specialty.
Move the sliders to see how a small leakage rate behaves across a primary care panel. This is an arithmetic illustration using an assumed $92 average allowed amount — not client data.
Interactive model
The shape of primary care revenue
An interactive illustration of the dynamic that defines billing in this specialty.
01
Front-end eligibility sweep
Scheduled visits verified in advance, with copay, deductible and referral requirement flagged back to the front desk before arrival.
02
Preventive/problem charge review
Same-day preventive plus problem encounters reviewed against documentation before payer submission, with modifier decisions documented and returned to the provider.
03
High-volume claim production
Daily charge entry and scrubbing tuned for volume: batch review, rejection triage the same cycle, and no claim left sitting in a clearinghouse queue.
04
Small-balance AR cadence
Patient-responsibility balances worked on a defined cycle rather than ad hoc, with clear escalation and write-off recommendations you approve.
05
Panel-level monthly review
Denials grouped by payer, provider and visit type so recurring patterns — modifier 25 rejections, wellness frequency edits, vaccine underpayment — become fixable items.
Interactive model
The shape of primary care revenue
An interactive illustration of the dynamic that defines billing in this specialty.
Coding & Charge Posting
Coding and charge posting handled with specialty context, so documentation,
Prior Authorization
Authorization requests initiated, tracked and documented so procedures are not
Credentialing & Enrollments
Coverage, benefits and patient responsibility checked before the visit,…
How this specialty is staffed
Ophthalmology accounts are run by a named team that works this discipline daily — charge entry and coding review, payer-specific scrubbing, denial root-cause follow-up and AR recovery, all inside your existing EHR and practice management system.
Get an Ophthalmology Revenue Health Check
A structured review of your ophthalmology denials, AR ageing and front-end workflow — with findings specific to this discipline.
